A Sunshine Act for Scotland

Over two years ago I raised a petition with the Scottish Parliament to urge the Scottish Government to introduce a Sunshine Act for Scotland.

The official Scottish Parliament page for my petition can be
accessed here. This page includes the petition history of PE1493
and all the written submissions made on behalf of this petition.

A Sunshine Act would make it mandatory for healthcare workers (and hopefully academics and all allied health professionals) to declare fully any payments including payments in kind. The argument I presented was that a single, searchable, independent register underpinned by statute would ensure transparency, promote scientific integrity, reduce the potential for harm and save money

Current Guidance in Scotland (HDL62 issued by the Scottish Government) has failed for more than 13 years. Other governance bodies, such as the Royal Colleges, have separate systems which also appear to have failed to ensure transparency of financial payments. These overlapping, but ineffective systems of governance duplicate costs and bureaucracy to nobody’s gain

My petition was closed earlier this month by the Scottish Parliament as the Scottish Government had committed to “update guidance”.

One of the actions of the Government in response to my petition was to commission a public consultation:

Last week the public voice of Scotland was revealed: the Scottish Public want sunshine:

The majority of participants felt that the publication of financial payments to healthcare professionals should be made mandatory. There is substantial evidence from other countries that the only effective way to make transparency mandatory is to have statutory legislation.

This is a landmark decision in the United Kingdom. By the voices of Scotland.

Of course there is much more to be done which requires energy and light.

However I have faith that the Scottish Government can provide this:

I want to thank a number of people:
◾the participants in the Public Consultation
◾Eleanor Bradford Health Correspondent for the BBC who first
suggested that I submit a petition to the Scottish Parliament
◾the Petitions Committee and its hard-working and dedicated clerks
◾John Pentland, MSP, former Convener, for being the first
in Parliament to agree that statutory measures were required
◾Chrys Muirhead, friend, activist, and critical thinker
◾The President and Vice President of the Royal College
of Psychiatrists (the College I am member of) for doing
their very best to improve transparency within the limitations
of current guidance

"Update": January 2017 from Scottish Government:
A year-on, that the Scottish Government keep the Scottish Public,
who supported my petition, in the DARK:

Update, 16th October 2016:
Below is a report in the Sunday herald which would seem to indicate
that the Scottish Government has chosen to ignore the majority of
Scottish people:

Some colleagues have asked an update on my campaign for a Sunshine Act for Scotland.

My petition PE1493 was closed in March of this year on a positive note: the Public Consultation found that the majority of the Scottish public wanted all payments from Industry to be disclosed as a mandatory requirement:

Following the closure of my petition, the Scottish Government promised to keep me up-to-date with progress, but despite occasional reminders to them I have heard nothing.

Meantime Scottish Government Guidance on declaring interests (HDL 62) seems to continue to be widely ignored across NHS Scotland

The body representing the pharmaceutical industry, the ABPI, has introduced this year a register ‘the Central Platform’ to cover the UK but it is not mandatory and there has been a most significant opt-out

Yesterday I was invited to the attached Educational Event in Scotland (Symposium for Mental Health and Learning Disabilities, NHS Lanarkshire, 4 Nov 2016) . This is a CPD-accredited meeting (CPD is the acronym for ‘Continuing Professional Development’). The programme states that it is sponsored “This meeting has been supported through funding of speaker fees and/or payment for hire of exhibition space by the following companies: Janssen, Lundbeck and Sunovion.”

Three of the speakers are being paid for their educational talks by Lundbeck. They are all what is termed “Key Opinion Leaders” and one of them is Chair of the Psychopharmacology Committee of the Royal College of Psychiatrists and also president Elect of the British Association of Psychopharmacology – there can be no two higher and more influential roles in prescribing behaviour in UK psychiatry. All three speakers have declared on the ABPI register.

I mention this forthcoming, CPD-accredited meeting as it picks up on the recent theme in the Medical Journals, that transparency can shine sunlight, but in itself cannot “disinfect”. To do so we need to separate the business of making money from science. On this front you may have seen the recent publicity about the financial conflicts of interest of one of the Chairs of a SIGN Guideline (SIGN issue Guidelines for NHS Scotland)

In Summary: Education of healthcare workers is now a measured and mandatory part of our job. There is however no way to establish the scale of the involvement of Industry in this education. My research for a Sunshine Act for Scotland has demonstrated that the scale is large; that it is almost impossible for healthcare workers in Scotland to receive education that does not risk bias by Industry; that most healthcare workers are unaware of this scale.

It is also clear to me that those doctors/academics/scientists/researchers who work for, and are paid by industry, do not recognise the potential for bias. As such they will continue to do as they have always done and in doing so will be supported by the medical profession. The medical profession, and science as a whole, has not been willing to take a firm stance. One potential and worrying consequence for the UK is that over-medicalisation may sink the NHS.

We need a Sunshine Act to wake up – to see in full day light what is happening.

However we will then need to work out a way of separating science from marketing (worldwide, drug companies give 1/3rd of their available revenue to drug development and 2/3rds to drug promotion)

Three years ago I began the process of raising a petition with the Scottish Parliament to urge the Scottish Government to introduce a Sunshine Act.

A Sunshine Act makes it a statutory requirement for all payments from commercial interests made to healthcare workers and academics to be declared publically. The metaphor is that sunshine brings full light. Both the United States of America and France have introduced a sunshine act.

The doctor in Gabriel García Marquez’ ‘Living to tell the tale’ says “Here I am not knowing how many of my patients have died by the Will of God and how many because of my medications”. Márquez often returns to the theme of medical ethics in his writings and reminds us that all interventions have the potential for benefit and harm. In ‘No one writes to the Colonel’, “a man [who] came to town selling medicines with a snake around his neck”. Here Márquez is reminding us of the long history of the financial opportunities open to healthcare professionals.

As a junior doctor in around 2000, I was handed by a Consultant a several hundred page document entitled “Behavioural and Psychological Symptoms of dementia”. The Consultant told me “this is the way forward!” Some years on I came to realise that this document had been developed, funded and disseminated by the Pharmaceutical Industry whose first loyalty, as a business, is to its share-holders.

In the wake of the dissemination of this document, prescribing of antipsychotics, sedatives and antidepressants in Scotland has been rising year on year. This has been described as mass prescribing, and is often long-term. Yet the evidence to support such prescribing is poor.

There is much promotion of “partnership working” between industry and healthcare. Yet we must remember that these two partners have different aims, and it is the responsibility of healthcare workers to follow the ethical approaches central to their professions. For example, the General Medical Council is clear about what is expected of doctors in their code “Good Medical Practice”. The potential for conflicts of interest is recognised and doctors are advised “you must be open about the conflict, declaring your interest formally”.

Since 2003, Scottish Government guidance has been in place to allow the declaration of financial interests of NHS staff, to their employing health boards. As a result of my petition, the Scottish Government has confirmed that this guidance is not being followed.

One key area of concern is the continuing professional education of healthcare professionals, another requirement of professional bodies. In at least two Boards in NHS Scotland, continuing medical education relies entirely on the financial support of commercial interests.

National and international conferences may also form part of continuing professional education. Because of the Sunshine Act in the USA, we know that a key-note speaker at a recent UK conference has been paid more than £3 million dollars by the pharmaceutical industry since the Sunshine Act was introduced. There is currently no way of knowing the scale of any payment made to a UK speaker sharing the same platform.

My experience of trying to clarify if there is transparency about financial payments in Scotland has been revealing. I have encountered significant defensive reactions from individuals and organisations. There has long been a body of evidence that, for example, prescribing behaviour is influenced by commercial interests, yet doctors find it hard to accept this. This collective denial would suggest that the forthcoming (voluntary) ABPI Register is unlikely to work as many will regard it as not applying to them and will therefore opt out.

As part of their consideration of my petition, the Scottish Government commissioned a public consultation exercise on a need or not for a Sunshine Act. The majority of participants expressed their view that all financial payments should be declared on a single, central, searchable register and that this should be a mandatory requirement.

The following investigation was by Paul Hutcheon and published in the Sunday Herald on 31 July 2016. The investigation is on SIGN Guideline 146 and whether there is sufficient public transparency by Healthcare Improvement of financially vested interests? The Chair of this Guideline was Professor David Newby, NHS Lothian. It is worth noting that like the majority of NHS Boards in Scotland that NHS Lothian continues to ignore Scottish Government Guidance (HDL 62) which was issued back in 2003 This Guidance was to all Chief Executives of all NHS Boards in Scotland and asked each NHS Board to set up a central register of all staff interests and to maintain this for full public transparency.

As an activist for transparency I welcome the Herald’s support. I have tried to seek support from Scottish Government, NHS Boards, GMC and Royal Colleges, but have not always found this straightforward

This is a forthcoming CPD module worth “10 points” as offered by the British Association of Psychoparmacology (BAP). It is described as a “Clinical Certificate” on “Anxiety Disorders”. It is organised by Professor David Nutt and Dr John Potokar. There is no mention of potential conflicts of interest on this BAP “Clinical Certificate”.

For at least three years I have asked BAP why declarations of interest can not be found by the public from their website. No action has ever been taken by BAP on this specifically.

From the ABPI Register one finds the following declarations (date 8 Dec 2016):

Professor David Baldwin
Psychiatry Community Mental Health Unit Southern Health NHSFee for service and consultancy Related expenses agreed in the fee for services or consultancy contract £9,889.57Lundbeck Ltd

In The “Psychiatric Bulletin” of December 2016 there is an interview with Vanessa Cameron, Chief Executive of the Royal College of Psychiatrists, 1984-2016.

The following is an extract. An extract which makes me wonder if the Chief Executive of the Royal College of Psychiatrists has ever looked at the evidence that others have established and that I have gathered here on Hole Ousia?

Less than two years ago this was debated in public by Dr Ben Goldacre and Professor Simon Wessely, President of the Royal College of Psychiatrists:

Last week (December 2016), at the NHS board I am employed with, LUNDBECK had organised one of their Reps to do a presentation on their new antidepressant BRINTELLIX. I refused to attend. That same week, the December edition of the British Journal of Psychiatry, was published, and as always it had a back page promotional advert. For many months these have been for medications for Adult ADHD but December 2016 was for LUNDBECK’s new drug Brintellix: